How Should a Diabetic Foot Ulcer Be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:
Prevention of infection.
Taking the pressure off the area, called "off-loading."
Removing dead skin and tissue, called "debridement."
Applying medication or dressings to the ulcer.
Managing blood glucose and other health problems.
Not all ulcers are infected; however if the physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

Keep blood glucose levels under tight control.
Keep the ulcer clean and bandaged.
Cleanse the wound daily, using a wound dressing or bandage.
Do not walk barefoot.
For optimum healing, ulcers, especially those on the bottom of the foot, must be "off-loaded." Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of "let the air get at it" is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. The physician can determine circulation levels with noninvasive tests.

Yao Ming is contemplating retirement

'Twas less than a week ago that the Houston Rockets introduced Brad Miller(notes) and his camouflage shorts as the newest member of their team. We applauded the great fit, and not just because of the abundant hunting opportunities. Not only would Miller be playing in a system that values his skills — passing, perimeter shooting, other things that start with "P" — but he'd also be stepping into a low-pressure situation where he could excel in limited minutes. It was all good, baby bay-bay.

However, it turns out we might be seeing a lot more of Brad Miller in the next few years. Because not only is Yao Ming(notes) unsure about how he will perform this coming season, he's also contemplating ending his career if his foot doesn't heal right. From the Associated Press:

In comments to Chinese state media Monday, Yao sounded far from optimistic about his future and also made a rare criticism of China's national basketball program.

"If the foot injury does not heal next season, I might choose to call it quits," he said. [...]

Yao, who has been in China to promote some of his charity events, all but ruled out playing in the 2012 London Olympics.

"The chance is very small," the 7-6 center was quoted as saying by the official Xinhua News Agency. "The foot injury will not allow me to play so many games anymore. Like I said before, I will quit the national team and the sport one day. It's what happens to every athlete."

Leave it to Yao Ming to be completely OK with his impending basketball mortality even though it's five years too early. It seems like just yesterday that Yao was sporting the pinstriped Rockets uniforms made famous by Matt Maloney, and now he's all but telling us he's almost done with the NBA. Somebody grab me some tissues.

Of course, there is a chance that Yao's foot will be fine this season. Zydrunas Ilgauskas(notes) went through a similar injury and surgery early in his career, and has played eight seasons since then. He was 23 when he broke his foot, which makes healing a lot easier than recovering from the same injury at 30.

I guess all we can do now is hope that Yao's foot turns out to be no big deal. Well, size 18 kicks are pretty large, but I meant "big" in a metaphorical sense. At the very least, the Rockets have the most enjoyable center ever signed for the next four years. It'd be tough to lose Yao, but those next three years would be filled with so many hearty laughs.